| NPI | 1114002458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q0188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00022057) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2023-03-20 |